摘要
目的分析张家口地区耐碳青霉烯铜绿假单胞菌(CRPA)流行病学特征变迁及其耐药机制,为区域性防控策略提供科学依据。方法收集2014年1月至2023年12月临床分离的铜绿假单胞菌3403株,其中CRPA 799株。采用分层随机抽样选择180株代表性菌株,检测碳青霉烯酶基因、OprD功能、外排泵活性和生物被膜形成能力。进行药物敏感性试验和协同效应测试,分析影响CRPA检出的危险因素。结果10年间CRPA总体检出率为23.47%,呈先升后降趋势,2019年达峰值34.33%,2023年降至3.33%。ICU科室检出率最高(49.66%)。82.22%菌株携带碳青霉烯酶基因,以blaVIM最常见(37.22%);86.11%存在OprD功能缺陷,70.00%外排泵过度表达。58.33%菌株具有生物被膜形成能力,与耐药率呈正相关(r=0.985)。多黏菌素E+美罗培南协同率最高(49.44%)。多因素分析显示碳青霉烯类暴露是最强独立危险因素(aOR=3.896,95%CI:3.074-4.938)。结论张家口地区CRPA检出率显著下降,但耐药机制复杂多样,多重机制并存现象突出。碳青霉烯酶产生、OprD缺陷和外排泵过度表达是主要耐药机制。生物被膜形成加剧耐药程度,多黏菌素E联合方案显示良好协同效应。
Objective To analyze the epidemiological characteristics and resistance mechanisms of carbapenemresistant Pseudomonas aeruginosa(CRPA)in Zhangjiakou,and to provide a scientific basis for regional prevention and control strategies.Methods A total of 3403 P.aeruginosa isolates from clinical settings were collected from January 2014 to December 2023,including 799 CRPA isolates.Stratified random sampling was used to select 180 representative isolates for testing carbapenemase genes,OprD function,efflux pump activity,and biofilm formation ability.Drug susceptibility testing and synergy testing were performed,and risk factors influencing CRPA detection were analyzed.Results The overall CRPA detection rate was 23.47% over the 10-year period,showing an increasing and then decreasing trend,reaching a peak of 34.33% in 2019 and decreasing to 3.33% in 2023.The highest detection rate(49.66%)was observed in the ICU.82.22% of the isolates carried carbapenemase genes,with blaVIM being the most common(37.22%).86.11% had OprD functional defects,and 70.00% had efflux pump overexpression.58.33% of the isolates had biofilm-forming ability,which was positively correlated with drug resistance(r=0.985).The synergistic rate was highest with polymyxin E plus meropenem(49.44%).Multivariate analysis revealed that carbapenem exposure was the strongest independent risk factor(aOR=3.896,95%CI:3.074-4.938).Conclusion The detection rate of CRPA in Zhangjiakou has significantly decreased,but the mechanisms of resistance are complex and diverse,with multiple mechanisms coexisting.Carbapenemase production,OprD deficiency,and efflux pump overexpression are the main resistance mechanisms.Biofilm formation exacerbates drug resistance,and the polymyxin E combination regimen demonstrates a strong synergistic effect.
作者
汤建华
刘云宁
李小凤
姜爱雯
蒲洁琨
樊毫军
TANG Jianhua;LIU Yunning;LI Xiaofeng;JIANG Aiwen;PU Jiekun;FAN Haojun(School of Disaster and Emergency Medicine,Tianjin University,Tianjin 300072,China;Department of Pharmacy,The First Affiliated Hospital of Hebei North University;Department of Microbiology,The First Affiliated Hospital of Hebei North University)
出处
《中国病原生物学杂志》
北大核心
2025年第12期1572-1578,共7页
Journal of Pathogen Biology
基金
河北省2025年政府资助临床医学优秀人才培养项目(No.ZF2025275)。
